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Precision medicine and the problem of structural injustice
AbstractMany countries currently invest in technologies and data infrastructures to foster precision medicine (PM), which is hoped to better tailor disease treatment and prevention to individual patients. But who can expect to benefit from PM? The answer depends not only on scientific developments but also on the willingness to address the problem of structural injustice. One important step is to confront the problem of underrepresentation of certain populations in PM cohorts via improved research inclusivity. Yet, we argue that the perspective needs to be broadened because the (in)equitable effects of PM are also strongly...
Source: Medicine, Health Care and Philosophy - May 25, 2023 Category: Medical Ethics Source Type: research

Temporal uncertainty in disease diagnosis
This study investigates how advancements in science and technology alter one type of uncertainty, i.e., temporal uncertainty of disease diagnosis. As diagnosis is related to anamnesis and prognosis it identifies how uncertainties in all these fields are interconnected. In particular, th e study finds that uncertainty in disease diagnosis has become more subject to prognostic uncertainty because diagnosis is more connected to technologically detected indicators and less closely connected to manifest and experienced disease. These temporal uncertainties pose basic epistemological and ethical challenges as they can result in ...
Source: Medicine, Health Care and Philosophy - May 24, 2023 Category: Medical Ethics Source Type: research

Precaution
(Source: Medicine, Health Care and Philosophy)
Source: Medicine, Health Care and Philosophy - May 1, 2023 Category: Medical Ethics Source Type: research

Empowerment: Freud, Canguilhem and Lacan on the ideal of health promotion
AbstractEmpowerment is a prominent ideal in health promotion. However, the exact meaning of this ideal is often not made explicit. In this paper, we outline an account of empowerment grounded in the human capacity to adapt and adjust to environmental and societal norms without being completely determined by those norms. Our account reveals a tension at the heart of empowerment between (a) the ability of self-governance and (b) the need to adapt and adjust to environmental and societal norms. We address this tension by drawing from the work of Freud, Canguilhem, and Lacan. First, we clarify through a discussion of Freud ’...
Source: Medicine, Health Care and Philosophy - April 27, 2023 Category: Medical Ethics Source Type: research

The biopsychosocial model: Its use and abuse
This article extends those critiques by showing how the BPSM ’s epistemic weaknesses have led to certain problems in medical discourse. Despite its lack of content, many researchers have mistaken the BPSM for a scientific model with explanatory power. This misapprehension has placed researchers in an implicit bind. There is an expectation that applications of the BPSM will deliver insights about disease; yet the model offers no tools for producing valid (or probabilistically true) knowledge claims. I argue that many researchers have, unwittingly, responded to this predicament by developing certain patterns of specious ar...
Source: Medicine, Health Care and Philosophy - April 17, 2023 Category: Medical Ethics Source Type: research

Body objectified? Phenomenological perspective on patient objectification in teleconsultation
AbstractThe global crisis of COVID-19 pandemic has considerably accelerated the use of teleconsultation (consultation between the patient and the doctor via video platforms). While it has some obvious benefits and drawbacks for both the patient and the doctor, it is important to consider —how teleconsultation impacts the quality of the patient-doctor relationship? I will approach this question through the lens of phenomenology of the body, focusing on the question—what happens to the patient objectification in teleconsultation? To answer this question I will adopt a phenomenolog ical approach combining both insights dr...
Source: Medicine, Health Care and Philosophy - April 8, 2023 Category: Medical Ethics Source Type: research

'You have to put a lot of trust in me': autonomy, trust, and trustworthiness in the context of mobile apps for mental health
AbstractTrust and trustworthiness are essential for good healthcare, especially in mental healthcare. New technologies, such as mobile health apps, can affect trust relationships. In mental health, some apps need the trust of their users for therapeutic efficacy and explicitly ask for it, for example, through an avatar. Suppose an artificial character in an app delivers healthcare. In that case, the following questions arise: Whom does the user direct their trust to? Whether and when can an avatar be considered trustworthy? Our study aims to analyze different dimensions of trustworthiness in the context of mobile health ap...
Source: Medicine, Health Care and Philosophy - March 30, 2023 Category: Medical Ethics Source Type: research

“Overestimated technology – underestimated consequences” – reflections on risks, ethical conflicts, and social disparities in the handling of non-invasive prenatal tests (NIPTs)
AbstractNew technologies create new complexities. Since non-invasive prenatal tests (NIPTs) were first introduced, keeping pace with complexity constitutes an ongoing task for medical societies, politics, and practice. NIPTs analyse the chromosomes of the fetus from a small blood sample. Initially, NIPTs were targeted at detecting trisomy 21 (Down syndrome): meanwhile there are sequencing techniques capable of analysing the entire genome of the unborn child. These yield findings of unclear relevance for the child ’s future life, resulting in new responsibility structures and dilemmas for the parents-to-be.The industry ...
Source: Medicine, Health Care and Philosophy - March 18, 2023 Category: Medical Ethics Source Type: research

Paternalistic persuasion: are doctors paternalistic when persuading patients, and how does persuasion differ from convincing and recommending?
AbstractIn contemporary paternalism literature, persuasion is commonly not considered paternalistic. Moreover, paternalism is typically understood to be problematic either because it is seen as coercive, or because of the insult of the paternalist considering herself superior. In this paper, I argue that doctors who persuade patients act paternalistically. Specifically, I argue that trying topersuade a patient (here understood as aiming for the patient to consent to a certain treatment, although he prefers not to) should be differentiated from trying toconvince him (here understood as aiming for the patient towant the trea...
Source: Medicine, Health Care and Philosophy - March 1, 2023 Category: Medical Ethics Source Type: research

Should responsibility be used as a tiebreaker in allocation of deceased donor organs for patients suffering from alcohol-related end-stage liver disease?
AbstractThere is a long-standing debate concerning the eligibility of patients suffering from alcohol-related end-stage liver disease (ARESLD) for deceased donor liver transplantation. The question of retrospective and/or prospective responsibility has been at the center of the ethical discussion. Several authors argue that these patients should at least be regarded as partly responsible for their ARESLD. At the same time, the arguments for retrospective and/or prospective responsibility have been strongly criticized, such that no consensus has been reached. A third option was proposed as a form of compromise, namely that ...
Source: Medicine, Health Care and Philosophy - February 13, 2023 Category: Medical Ethics Source Type: research

Pandemics and the precautionary principle: an analysis taking the Swedish Corona Commission ’s report as a point of departure
AbstractIn the initial phase of the COVID-19 pandemic, Sweden ’s response stood out as an exception. For example, Sweden did not introduce any lockdowns, while many other countries did. In this paper I take the Swedish Corona Commission’s critique of the initial Swedish response as a point of departure for a general analysis of precaution in relation to pa ndemics. The Commission points out that in contrast to many other countries Sweden did not follow ‘the precautionary principle’. Based on this critique, the Commission proposes that the precautionary principle should be included among Sweden’s guiding principle...
Source: Medicine, Health Care and Philosophy - February 13, 2023 Category: Medical Ethics Source Type: research

“Ruptured selves: moral injury and wounded identity”
We describe how moral injury ruptures one ’s sense of self leading to moral disorientation. The article concludes with implications for moral repair. Since moral identity is relationally formed, moral repair is not primarily an individual task but requires the involvement of others to heal one’s identity. The repair of moral injury requ ires the transformation of a moral identity in community. (Source: Medicine, Health Care and Philosophy)
Source: Medicine, Health Care and Philosophy - February 13, 2023 Category: Medical Ethics Source Type: research

Correction to: The role of knowledge and medical involvement in the context of informed consent: a curse or a blessing?
(Source: Medicine, Health Care and Philosophy)
Source: Medicine, Health Care and Philosophy - February 13, 2023 Category: Medical Ethics Source Type: research

The impairment argument, ethics of abortion, and nature of impairing to the n  + 1 degree
AbstractI argue here that the impairment principle requires clarification. It needs to explain what makes one impairment greater than another, otherwise we will be unable to make the comparisons it requires, the ones that enable us to determine whether b really is a greater impairment than a, and as a result, whether causing b is immoral because causing a is. I then develop two of what I think are the most natural accounts of what might make one impairment greater than another. The quantitative understanding of greater impairment is problematic because it leaves the impairment principle vulnerable to counterexamples; just ...
Source: Medicine, Health Care and Philosophy - January 27, 2023 Category: Medical Ethics Source Type: research

ChatGPT: evolution or revolution?
(Source: Medicine, Health Care and Philosophy)
Source: Medicine, Health Care and Philosophy - January 19, 2023 Category: Medical Ethics Source Type: research